The Goals of COPD management include:

Prevent disease progression

Relive symptoms

Improve exercise tolerance

Improve health status

Prevent and treat complications

Prevent and treat exacerbations

Reduce mortality

Prevent and minimize the side effects from treatment

Achieving of the goal we envision through implementation of

A COPD management program (GOLD Guidelines) with four major components:

Assess and monitor Disease

Reduce Risk factors

Manage Stable COPD

Manage Acute Exacerbations

Disease condition and diagnostic

Description of condition

Differential Diagnosis with other respiratory conditions (# Asthma)

Managing of comorbidities

Description of stable COPD

Severity level and corresponding interventions

Identification of exacerbation and corresponding interventions

COPD program is applicable with Healthy Return System

Smoking cessation

Source

/

Contact

/ Program features /

Population

/

Duration

/ Program Cost / Success rate / Cons /

Pro

Continental Health Promotion / Bridgit Mitchel
804-780-0078 /
  1. Participant’s
  2. Initiative phone call
  3. Two groups identification:
  4. contemplation
  5. “Three weeks goal set” by “Cold Turkey”
  6. or NR education material
  1. Four Out-bounding phone calls
  2. (third day , and quarterly)
  3. On- site visit
/ VA State Employee / 12 month / N/A
Pending / 15 % Projected / Lack of experience / Baby Benefit collaboration with HMC
Face to face interaction
Gordian Health Solutions,
/ at 1-888-Gordian (1-888-4673426)
Rodger Read
615-844-2100 /
  1. Over phone survey with a goal setting within the next 30 days
  2. Quitting kit
  3. 5outbounding calls
  4. Unlimited in bounding calls
  5. 6 mail
  1. +NR(two weeks supply)
/ Randomly / 12 month / $175.00 PMPY
$31.00(NRT / 13%
21%
Blue Print for Health Stop Smoking / Mary Hartman
888-878-039 ext.27728
Msg Left /
  1. Educ.
  2. Tobacco Replacement therapy
  3. Pharmaceutical
/ Randomly / 12 month / Pending / Pending
(MSG left on 15 July)
Health Media / Alan Sneider
/
  1. Mail,
  2. Internet Survey
  3. Analysis
  4. Tailored Plan
  5. News Letters
Breath Program
Breath Advantage Program (smoking cessation
Weight and stress management ) / Randomly / 12 month / $99.00-$132.00 / Distribution list,
Pricing model
Harris Health Trends.com
Harrishealthtrends.com / 419-885-510
John Harris / 1. Telephonic smoking cessation:
Cessation phase 4 by 8 min :
re-assess the stages of readiness
assess the level of knowledge
establish a plan for action
inform the participant on what
to expect
5 Relapse by 4 minutes
2.Webbased support
3.mail in material / Randomly / 12 month / 23%-61% / $140.00 per participant
no nicotine replacement therapy / Collab.with HMC

Recommendations:

The most suitable vendor for implementation of smoking component of the COPD program can be Harrison Health Trends

The components of the vendor’s program are sufficient and in correspondence with the HMC philosophy.

The following criteria have been placed into the process of evaluation:

  • Reliability (previous collaboration -General Board of Pension and Health Benefits of the United Methodist Church),
  • years of experience(14) ,
  • unique approach in identification of participants and act plan,
  • success rate ( 23-61%)

The increase of success rate corresponds with tobacco replacement therapy,

Details on pricing model are pending.

Comparison analysis of cost in house development and vendor has been conducted and evaluated

Outcome measure of the Program

Outcome measures: COPD

Outcome measures / Population measured / First assessment / Last assessment / Client goal / Data source1 / Data source2 / Baseline measure / Baseline source / Outcome source *
Participant knowledge
Risk factor identification/recognition / High intensity / XX% / XX% / >80% / DPP / HMC

Risk factor avoidance

/ High intensity / XX% / XX% / >70% / DPP / HMC
Has MD instruction for exacerbation / High intensity / XX% / XX% / >70% / DPP / HMC

Medication use

Bronchodilator or combination
Bronchodilator /corticosteroid use /

ALL

/ >60% / Claims / DPP / GOLD
Use inhaler correctly / High intensity / XX% / XX% / >80% / DPP / GOLD
Activity tolerance therapy
% Participating in pulmonary rehabilitation or other activity tolerance therapy / High intensity / XX% / XX% / DPP / GOLD
Home oxygen Therapy Use
% On long-term home oxygen>17hrs. /day / High intensity / XX% / XX% / DPP / GOLD
Diagnostic testing
FEV 1 / High intensity / XX% / XX% / DPP / GOLD
%Receiving diagnostic testing annually or as complications occur / High intensity / XX% / XX% / DPP / GOLD
Clinical/ life style measures
%Who smoke / ALL / XX% / XX% / <15% / DPP
%Who quit smoking / ALL
%Who advised to quit smoking by MD / ALL / XX% / XX% / >90% / DPP / 100% / DPP / GOLD
Functional status
% Reporting improved physical condition / High intensity / XX% / XX% / >30% / SF-12 / HMC
% Reporting improved mental condition / High intensity / XX% / XX% / >30% / SF-12 / HMC
% Reporting mild/moderate symptoms / High intensity / XX% / XX% / >80% / DPP / HMC
% With no/slight activity limitation / High intensity / XX% / XX% / >90% / SF-12 / HMC
Avg.# days of lost activity (w /in last 90d) / High intensity / ## Days / ## Days / <4 days / DPP / HMC
Healthcare utilization (high intensity only for reports w/o claims
% Receiving care at least once annually last 12 mo / All / XX% / XX% / >85% / Claims / DPP / HMC
% Hospitalized for COPD_last 12 mo / All / XX% / XX% / <5%
<8% / Claims / DPP / HMC
% With ER visit-last 12 mo / All / XX% / XX% / <50%
<10% / Claims / DPP / HMC
% With unscheduled MD visit last 12 mo / High intensity / XX% / <10% / DPP / HMC

*GOLD =Global Initiative for Chronic Obstructive Disease and joint effort between the NHLB and WHO, WHO- World Health Organization, NHLB= National Heart, Lung and Blood Institute a division of National Institute of Health

Competitive analysis HMC on the market

Airlogix / Features of Program / COPD Contracts / Other Disease States Managed
Cor Solution /
  • Smoking cessation program
  • Nurses trained in COPD
  • Home visits for assessment and interventions by respiratory therapist
  • Senior –specific DMprogram(Senior Logix)
  • Medication education
  • Plans for crisis episodes
  • “self-wellness” care management
/ Blue Cross Blue Shield of Kansas City:
Pacific Care (CA and TX) / Asthma
Life Masters /
  • “Life masters on line” – smoking cessation tools, education materials,
  • Medication
  • Management,
  • Data tracking,
  • Telephonic management program with nurses
/ Highmark Blue Cross Blue Shield (Blues Call Program) / CHF
CAD
Diabetes
Asthma
Caremark, Inc /
  • 24 hours nurse lines,
  • Telephonic management
  • Educational materials,
  • “Face-to –face” education, as needed scheduled assessment,
  • Medication management
/ Asthma,
CAD
Diabetes
Osteoarthritis
Peptic ulcer disease
Hemophilia
Hepatitis, CAD COPD
National Jewish Medical and Research Center /
  • Smoking cessation program (just quit-telephonic or web based
  • Lung line - nurse line,
  • Ling facts
  • Audio library, telephonic care management, on line learning center
  • Peak flow meter monitoring
  • Reactive care line,
  • Care manager
/ Partnership with Boehringer Ingelheiim Pharmaceuticals / Asthma
Matria /
  • Service by respiratory specialty nurses, home health nurses, physical therapist
  • Occupational therapist
  • Lung Line – nurse line
  • Ling facts –audio library
  • Educational programs for clinic
/ Partnership with National Jewish / Diabetes,
Asthma
American Healthway /
  • Telephonic Care management
  • Home pulmonary rehabilitation services
  • Patient and provider education
  • Web based service
/ Vytra Health Plans: Blue Cross and Blue Shield of Minnesota (though My Health Plans) / Diabetes, CHF, CAD, Asthma,
Population health management (renal decease, rare disease and 21 impact conditions)

Our position and strategic approach

Cost of the Program

Recommendations

References

List of reviewed literature and /Note(from previous presentation)

Note from the President:

1.Goal:

A program in place that produces demonstrable results at reasonable prices in 2002.

Position us effectively (wit clients vs competitors) across all parameters:

Goals

Strategic approach to managing the condition

Specific content and tools, including reporting

Outcomes

Financial Return for clients

Price

Questions to answer:

What is our strategic approach?.

How will we compete on it?

Competitors have much more focus on

home based assessment,

monitoring and therapies than we seem to have.

What is the rationale for this?

Lower cost ? Improved results?

Seems to focus primarily on focus cessation as the primary strategy?

How will we compete?

The natural questions are about how effective smoking cessation is with COPD population,

What are the drivers of success,

What outcomes can be expected?